Guilford County, North Carolina’s positivity rate is ticking up.
As public health chief for the county of 530,000, it’s Iulia Vann’s job to fight it with any tool she has.
The most effective option — a COVID-19 vaccine — is about to come online. But for Vann and many others in her position around the country, the question of how to get the shot into the arms of 330 million Americans remains unaddressed.
Congress has yet to appropriate any money for vaccine distribution. While the federal government has spent billions of dollars developing vaccines to prevent COVID-19, not a single federal dollar has been passed for the purpose of conducting the inoculation campaign itself.
Guilford County, which received $94 million in CARES Act funding that expires Dec. 31, expects to scrape together $1.2 million for public health in 2021.
“We’re trying to get it done, but it’s going to be hard,” Vann told TPM. “It’s disheartening to see that we don’t have that support to do our work without having to worry.”
In many cases, TPM found, local public health departments are in a similar place to Guilford County’s: they’ve spent months focused on fighting the pandemic, but have only just begun to plan for distributing the COVID-19 vaccine en masse. As they turn to that task, they face little help from the federal government; as the months have gone by, Congress has been unable to reach a deal on money for vaccine distribution.
Already burdened by limited budgets and what CDC Director Robert Redfield described as the “the most difficult” months in the history of U.S. public health, local departments could face delays in getting the life-saving shot out to their populations absent federal support as they lack cash to hire vaccinators, spread the word about how to get the vaccine and ensure that people show up for both shots of the two-dose inoculation.
The Department of Health and Humans Services and Centers for Disease Control and Prevention have doled out around $340 million to the states in funding for vaccine distribution. But that falls far short of the $8.4 billion that state officials say is needed to effectively deploy the vaccine.
“It’s going to show itself in a slower response, potentially missing the folks who are oftentimes missed when it comes to efforts like this,” Adriane Casalotti, chief of government relations at the National Association of City and County Health Officials, told TPM.
Problems in the states
Congress passed the CARES Act in March, which granted billions of dollars in funds for local governments around the country to fight COVID-19 with an expiration date of Dec. 31.
The money was not targeted specifically at public health, though many local governments allocated the money to their public health departments.
Since then, the Trump administration has developed plans to vaccinate the initial categories of recipients — health care workers and nursing home residents — through distribution to hospitals and via a public-private partnership with pharmacies for long-term care.
But the question of who will vaccinate the rest — the vast majority — of the population falls to the states and their constituent local public health departments.
The hard-hit state of Wisconsin is slated to receive 65,000 doses of the vaccine in the next two weeks, and Department of Health Services Deputy Secretary Julie Willems Van Dijk said Monday that she anticipates the first doses will be given out before the end of December. It’ll take a “number of months” to vaccinate everyone in Wisconsin, Van Dijk said — and the state still needs to find the money to do it.
The state will need at least $12 million for vaccine distribution, according to Gov. Tony Evers (D), part of an additional $466 million to fight virus. A weary Evers said during a press conference last week that he’d sent letters to the Wisconsin congressional delegation and HHS begging for more federal funding.
At the same press conference, Health Services Secretary-Designee Andrea Palm said that the state was also looking into alternative revenue streams, to create some kind of safety net should Congress fail to act again. She mentioned a $2 million grant from the CDC for which the state is currently applying.
“At the end of the day, the federal government needs to step up to the plate,” Evers sighed.
Public health departments nationwide are already cash-strapped heading into 2021, in part because CARES Act funding expires Dec. 31. They don’t have enough money on their own to fund their anti-COVID operations, which already far exceed the cost of their normal operations. At the same time, they’re being asked to plan to distribute a COVID vaccine without any additional funding, putting additional strain on resources that are already woefully insufficient.
Jeff Duchin, public health chief for King County, Washington, where Seattle is located, said that his county had enough money to fund a little more than a month of operations in 2021 — and that doesn’t including vaccine planning.
He referred to Operation Warp Speed, the Trump administration’s effort to accelerate vaccine development, as “operation status quo with respect to providing the federal funding needed for state and local health departments to actually get the vaccine to the population.”
That means that in many cases, even as the vaccine becomes available, plans for how to distribute it remain in their early stages. Though Wisconsin’s vaccine distribution plan does name local public health departments as part of the coordination and distribution effort, some Wisconsin counties told TPM they were awaiting clarity from the state on how distribution would work.
“Although we expect to be involved in vaccine distribution, the state health department’s plan does not at this time include a public health role,” said Sarah Mattes, communications supervisor for Public Health Madison & Dane County, home to Madison.
Waukesha County near Milwaukee, the state’s third most populous, is preparing to serve as a “community partner” in the vaccine distribution process, a county spokesperson told TPM.
“It is likely that federal aid would fund staffing to help coordinate vaccination efforts at the local level,” Waukesha County Health and Human Services spokesperson Linda Wickstrom said, adding that plans had not yet been developed for the county to know where else future federal funding would be needed.
Hard trade offs
Pamela Brown, public health chief for Lenoir County, North Carolina, told TPM last week that her office had begun developing its vaccination plan, complete with requests for supplies. But, she said, the planning for distribution is coming amid a surge of cases in the area.
“When we have a spike of cases, I don’t get a spike in staff,” Brown said.
But the problems with lack of funding will likely become more acute as the vaccine itself becomes more widely available.
Vann, the Guilford County health department leader, said that it would be extremely difficult for her office to train and hire new staff to vaccinate the area en masse. She would like to hire vaccinators, but the end of CARES Act funds on Dec. 31 and lack of new money made the task nearly impossible.
“We don’t have the funds to support additional staff or overtime for our team members, who are working 80 hours per week,” Vann said. “That really affects the entire process.”
She added that while the county planned on opening vaccination sites, it wasn’t yet clear where the money would come from to operate them.
“We’ll have to shift things around in our own regular operations,” Vann said. “The bottom line is that we will find ways to do it — but it’s just going to be really difficult, and I don’t want to lose my team because we’re trying so hard.”
Casalotti, the NACCHO official, told TPM that even if Congress were to fund the effort tomorrow, it could take weeks for the money to arrive due to red tape and the lack of a clear mechanism on how to move federal funds to the country’s disparate 3,000 public health departments.
“So much of this response has been in crisis mode, asking how to fund what should have already been going on, how do we put out fires,” Casalotti said. “We’ve been asking for months and months now to make these investments as one area where we wouldn’t have to put out a fire after it started. But we’re now at a place where it’s past time.”
This story has been updated.